m.r.bill-mandal
TRANSCRIPT
MEDICAL REIMBURSEMENT BILL PREPARATION
INSTRUCTIONS
1. Go to DATA Sheet
2. find the fallowing heads and enter the data in the relavant fields and select SAVEAS option and save the file with your name
1.DATA OF THE EMPLOYEE FOR MEDICAL REIMBURSEMENT BILL PROPOSALS
II.PERTICULARS FOR BILL CLAIM AFTER SANCTIONING THE AMOUNT BY AUTHORITIES
3. For midical reimbursement bill proposals enter the data in the 1st head
print the sheets in the order 1.proceed , 2.CHECKLIST ,3.CHECKLIST2,4.APPENDIX 5.APPLICATION FORM, 6,NON DRAWL -DEPENDENT CERITFCATE
4. After the proposals are accepted and the sanctioning of the bill ,enter the data under 2nd head and print the sheets from " f58" to "back47" sheets
5. submit the bills to the treasury
[email protected] www.apteachers.blogspot.com
MEDICAL REIMBURSEMENT BILL PREPARATION
2. find the fallowing heads and enter the data in the relavant fields and select SAVEAS option and save the file with your name
1.DATA OF THE EMPLOYEE FOR MEDICAL REIMBURSEMENT BILL PROPOSALS
II.PERTICULARS FOR BILL CLAIM AFTER SANCTIONING THE AMOUNT BY AUTHORITIES
print the sheets in the order 1.proceed , 2.CHECKLIST ,3.CHECKLIST2,4.APPENDIX 5.APPLICATION FORM, 6,NON DRAWL -DEPENDENT CERITFCATE
4. After the proposals are accepted and the sanctioning of the bill ,enter the data under 2nd head and print the sheets from " f58" to "back47" sheets
by
Sreenivas Gandhamaneni
School Asst (Maths)
Govt.High school No.1
Old Town ,Anantapur- 515001
cell :-99594 22002 - 94402 69989www.apteachers.blogspot.com
1.DATA OF THE EMPLOYEE FOR MEDICAL REIMBURSEMENT BILL PROPOSALS
S.NOPARTICULARS NAME EMP ID BANK A/C
DDO CODE AND A/C NO 1003567-0092 123456
1 NAME OF THE EMPLOYEE Sri Y.Gangi Reddy 11111234567 123456789023 TREASURY OFFICE DIST TREASURY OFFICE DTO
2 NAME OF THE DEPENDENT-AGE smt resma TREASURY PLACE - CODE ANANTAPUR 80
3SELF OR RELATION SHIP WITH EMPLOYEE
wife of w/o SALARY BANK NAME STATE BANK OF INDIA SBI
4 DESIGNATION AND SECTION S.G.T EDN SECTIOM BANK PLACE-CODE B.K.SAMUDRAM
5 SCHOOL/OFFICE MPUP SCHOOL R.C.No.5601/B5/2007
6 PLACE CHADULLA AMOUNT SANCTIONED 8660
7 Mandal SINGANAMALA Mandal MP eight thousand six hundred and sixty only
8 DISTRICT Anantapur .Dt Anantapur
9RESIDENTIAL ADDRES D.No.12/153,Cental Excise Colony,Sai Nagar,Anantapur by
10 Residence Sreenivas Gandhamaneni
11 SUFFERING FROM Sever Attrition,Badly decayed teeth School Asst (Maths)
12 TREATMENT GIVEN Consultation.Root canal treatment,Ceramic crowns Govt.High school No.1
13 DURATION OF TREATMENY 10/10/2009 10/20/2009 Old Town ,Anantapur- 515001
14 HOSPITAL NAME & REGD NO Dentocare Super Speciality Hospital cell :-99594 22002 - 94402 69989
15 PLACE AND TYPE OF HOSPITAL Anantapur Referal
17 DOCTOR NAME-REFERED DOCTOR DR.M.Venkata Krishna Murthy
19 NO of CONSULTATION and FEE RS 1 100
20 HOSPITAL EXPENDITURE RS 8660
21PAY OF THE EMPLOYEEE
BAISC DA HRA CCA IR O/A TOTAL PAY SCALE
22 7970 4805 797 80 1753 300 15705 5750--13030
23 DRAWING OFFICER MANDAL EDUCATIONAL OFFICER M.E.O
24 DDO OFFICE- PLACE MANDAL PRAJA PARISHAD M.P.P M.P.SINGANAMALA
25Sri H.kadirappa B.A,B.Ed
II.PERTICULARS FOR BILL CLAIM AFTER SANCTIONING THE AMOUNT BY AUTHORITIES
IF ,SELF DO NOT ENTER iN THIS COLOR BOXES
PROCEEDIN RC NO OF BILL SANCTIONING AUTHORITY & DATE
ILLNESS FELT AT RESIDENCE/OTHER PLACE
www.apteachers.blogspot.comRupees eight thousand six hundred and sixty only [email protected]
DRAWING OFFICER NAME & QUALIFICATION
26
DIST.EDUCATIONAL OFFICER O\O D.E.O ANANTAPURSANCTIONING OFFICER- OFFICE - PLACE
27 PROCEEDINGS RC-NO OF DDO 335/2009/B 11/12/2009
From To,
Sri/Smt H.kadirappa DIST.EDUCATIONAL OFFICERB.A,B.Ed O\O D.E.O
MANDAL EDUCATIONAL OFFICER ANANTAPURM.P.SINGANAMALA
Rc.No:- 335/2009/B Date:- ###
Respected sir,
Sub:-
Ref:- 1).
2).
3).
<<<<<<<<<< 0>>>>>>>>>>
I request you to sanction the Medical Reimburement to the individual as early possible
Thanking you sir
yours faith fullyEnclosers
1 Apendix -II2 Essentiality Certificate3 Non Drawl Certficate4 All Medical Bills5 Emergency Certificate6 Discharge Summary7 Check list8 Dependence Certificate
Srinvas Gandhamaneni - 99594 22002 * 9440269989 "www.apteachers.blogspot.com"
API Medical Attendence Rules-Medical Reimbursement bill of Rs
8660/- pertaining of smt resma w/o Sri Y.Gangi Reddy, S.G.T,
MPUP SCHOOL,CHADULLA, SINGANAMALA Mandal,
Anantapur .Dt -proposals submitted - orders -requested -Regd
G.O.M.S.No.105,HM & FW ,Dated 09-04-07 of Govt of Andhra Pradesh,A.P, Hyderabad
G.O.M.S.No.74,HM & FW ,Dated 15-03-05 of Govt of Andhra Pradesh,A.P, Hyderabad
Application of Sri/Smt Y.Gangi Reddy, S.G.T, MPUP SCHOOL, CHADULLA, SINGANAMALA Mandal, Anantapur .Dt
I submit that the smt resma w/o Sri Y.Gangi Reddy, S.G.T, MPUP SCHOOL,
CHADULLA, SINGANAMALA Mandal, Anantapur .Dt, Was under gone the treatment with
Consultation.Root canal treatment,Ceramic crowns, at Dentocare Super Speciality Hospital
Anantapur, from 10-10-09 to 20-10-09 and spent an amount of Rs 8660/- ( Rupees eight thousand
six hundred and sixty only ) for the treatment and requested for Medical Reimbursement
Hence I am here with submitting the Medical Reimbursement Proposals in respect of smt
resma w/o Sri Y.Gangi Reddy, S.G.T, MPUP SCHOOL, CHADULLA, SINGANAMALA Mandal,
Anantapur .Dt with all fullfill requirements for payment
(MEDICAL REIMBURSEMENT)
1 Name of the Employee Y.Gangi Reddy
2 Designation and Basic pay S.G.T, Basic pay Rs 7970/-
3 Section and Office in which Employed
4 Actual Residential Address with Door No D.No.12/153,Cental Excise Colony,Sai Nagar,Anantapur
5
DR.M.Venkata Krishna Murthy
6 Dentocare Super Speciality Hospital, Anantapur ,
7 smt resma wife of Y.Gangi Reddy
8 Nature of the Decease Sever Attrition,Badly decayed teeth
( copy enclosed )
9 From 10-10-09 to 20-10-09
10 Details of Medical Charges incurred
I MEDICAL ATTENDENCE
a)NO Fee Rs
1 100
b)
c)
d) 8660
Essentiality Certificates and Bills are Enclosed here with
II HOSPITAL TREATMENT
a) Accommmodation charges
b) Pharmacy Charges
c) Lab Charges (Details Shall be furnished)
d) Surgeon's Fee
e) Assist.Surgeon's Fee
f) Anesthetic fee
g) Theatre Charges
h) Blood Charges
i) Nursing Charges
11 Total Amount Claimed 8660
12 Less Advance Received
13 Net Amount Claimed 8660
14 No.Of Enclosures
FORM OF APPLICATION FOR MEDICAL CLAIMS
EDN SECTIOM MPUP SCHOOL, CHADULLA, SINGANAMALA Mandal, Anantapur .Dt
Office and place where wife / husband is Employed
Name of the Medical Attendent and address and Name of the Hospital with Regd No
Name of the Patient and his / her relation ship to the Govt Servent ( In the case of children, state Age also)
Period of treatment as in-patient as indicated in the certificates &Hospitalisation
The Number and Dates of Consultaions and Fee paid for each consultaion
The Number and Date of Injections and fess paid for injections
Details of Laboratory Tests,X-rays ,and Scan etc
The Number and Dtae of Costs of Medicines(Details of the consolditated Medicines shall be furnished in the Essentiality Certificate)
Srinvas Gandhamaneni - 99594 22002 * 9440269989 "www.apteachers.blogspot.com"
DECLARATION TO SIGNED BY THE GOVERNMENT EMPLOYEE
M.E.OM.P.SINGANAMALA
I here by declare that the statement in this application are true to the best of my knowledge and that The person
for whom medical expenses were incurred is a member of my family as defined in API Medical Attendence
Rules.He/She is dependent on me.Certified that my dependent is not a Govt.Employee.
SIGNATURE OF THE GOVT. EMPLOYEE/PENSIONER AND THE OFFICE TO WHICH HE IS ATTACHED
CHECK SLIP FOR SENDING MEDICAL REIMBURSEMENT PROPOSALS
S.NO
1 Name and Official Address of the Teacher
Y.Gangi Reddy
S.G.T
MPUP SCHOOL CHADULLA
SINGANAMALA M.P , Anantapur .Dt
2 Dates of Treatments From 10-10-09 to 20-10-09
3 Name and Address of the Hospital
4 Whether Private or Government Referal
5
6
7
8
9
10 Whether the Discharge summary of the patient is enclosed ?
11
12
Drawing and Disbursing Officer
Dentocare Super Speciality Hospital, Anantapur
Whether the proposal is received in the head Office within a period of six months from the date of discharge ?
Whether Appendix - II attested by the Head of the Office is enclosed ?
In case of treatment at Recognised Hospital / NIMS / SVIMS whether Emergency certificate is enclosed ?
Whether Essentiality certificate mentioning the amount of expenditure for the treatment, signed by the Doctor who treated and attested by the Authorised Medical Agency is enclosed ?
Whether the Bills for the amount mentioned in the Essentiality certificate , signed by the Doctor , who treated and attested by the Authorised Medical Agency is enclosed ?
In case of retired Govt Employe / Teacher, whether the copy of the pension payment order is enclosed ?
Incase of dependents above the age of 19 years unemployement and Dependency Certtificate,counter signed by the Head of Office is enclosed ?
Srinvas Gandhamaneni - 99594 22002 * 9440269989 "www.apteachers.blogspot.com"
(MEDICAL REIMBURSEMENT)
Indicate 'YES' or 'NO' in the brackets against each item
1
2
3
4
5
6
7
8 All the cash reciepts are with in the period of treatment
9
10
11
12
13
Drawing and Disbursing Officer
CHECK SLIP TO BE SIGNED AND FURNISHED BY THE GOVT.EMPLOYEES
All the columns of the Application form have been filled in properly
The bill has been submitted along with Essentiality Certficate "A" for the treatment as out-patient by furnishing all the particulars and signed by the Medical Attendent who treated the patient
The bill has been submitted along with Essentiality Certficate "B" for the treatment as Int-patient by furnishing all the particulars and signed by the Medical Attendent who treated the patient and counter signed by the Head of the Hospital
The name of the disease has been indicated in the Essentiality certificate in Block letters
The period of treatment has been indicated in the Essentiality certificate
The case Doctor has signed on the Essentiality certificate and counter signed by the Head of the Hospital
All the columns of theEssentiality certificates 'A' , 'B' have been filled in properly
The cash reciepts have been counter signed by the Doctor who treated the patient
The name of the patient and the name of the Doctor has been indicated in all the cash receipts
All the cash reciepts enclosed to the Medical reimbursement claim are dated
The total amount of cash receipt tallied with the amount claimed
The Duplicate bill with the copies of the original bills has been submitted
SRINIVAS GANDHAMANEN I - 99594 22002 - 94402 69989
(MEDICAL REIMBURSEMENT)
Indicate 'YES' or 'NO' in the brackets against each item
Sign of the Employee
CHECK SLIP TO BE SIGNED AND FURNISHED BY THE GOVT.EMPLOYEES
SRINIVAS GANDHAMANEN I - 99594 22002 - 94402 69989
APPENDIX -II (MEDICAL REIMBURSEMENT)
1 Name,Designation & SectionY.Gangi Reddy
S.G.T EDN SECTIOM
2 Office in which Employed MPUP SCHOOL CHADULLA
SINGANAMALA M.P , Anantapur .Dt
3
PAY DA HRA CCA IR O/A
7970 4805 797 80 1753 300
Rs 5750--13030
4 Place of Duty
5 Full Residential Address with Door No D.No.12/153,Cental Excise Colony,Sai Nagar,Anantapur
6 smt resma wife of Y.Gangi Reddy
7 Place at which the Patient fell ill Residence
8 Nature of the illness and its Duration From 10-10-09 to 20-10-09
( copy enclosed )
9
Rs 8660/-
Essentiality Certificates and Bills Enclosed here with
10 Total amount claimedRs 8660
#VALUE!
11 List of enclosures
1 Hospital Reports 5 Emergency Certificate
2 Essentiality Cert 6 Discharge Summary
3 Non Drawl Certfi 7 Check list
4 All Medical Bills 8 Dependence Certificate
( All Originals in Duplicate Submitted )
DECLARATION TO SIGNED BY THE GOVERNMENT EMPLOYEE
M.E.O
APPLICATION FOR CLAIMING REFUND OF MEDICAL EXPENSES INCURRED IN CONNECTION WITH MEDICAL ATTENDENCE AND / OR TREATMENT OF GOVERNMENT EMPLOYEE AND THEIR FAMILES
Pay of the Govt.Servent as defined Which should be shown separately
MPUP SCHOOL, CHADULLA, SINGANAMALA , Anantapur .Dt
Name of the Patient and his / her relation ship to the Govt Servent ( In the case of children, state Age also)
Details of amount claimed ,cost of Medicines purchased from the market / list of Medicines , Cash memos, and the Essentiality Certficate should be attached.Each in duplicate signed by treatment Doctor
I here by declare that the statement in this application are true to the best of my knowledge and that The
person for whom medical expenses were incurred is a member of my family as defined in API Medical
Attendence Rules.He/She is dependent on me.Certified that my dependent is not a Govt.Employee.
SIGNATURE OF THE GOVT. SERVENT/PENSIONER AND THE OFFICE TO WHICH HE IS ATTACHED
M.P.SINGANAMALA
Srinvas Gandhamaneni - 99594 22002 * 9440269989 "www.apteachers.blogspot.com"
APPENDIX -II (MEDICAL REIMBURSEMENT)
Y.Gangi Reddy
S.G.T EDN SECTIOM
MPUP SCHOOL CHADULLA
SINGANAMALA M.P , Anantapur .Dt
TOTAL
15705
Rs 5750--13030
D.No.12/153,Cental Excise Colony,Sai Nagar,Anantapur
smt resma wife of Y.Gangi Reddy
Residence
From 10-10-09 to 20-10-09
( copy enclosed )
Rs 8660/-
Essentiality Certificates and Bills Enclosed here with
#VALUE!
Emergency Certificate
Discharge Summary
Dependence Certificate
( All Originals in Duplicate Submitted )
DECLARATION TO SIGNED BY THE GOVERNMENT EMPLOYEE
APPLICATION FOR CLAIMING REFUND OF MEDICAL EXPENSES INCURRED IN CONNECTION WITH MEDICAL ATTENDENCE AND / OR TREATMENT OF GOVERNMENT EMPLOYEE AND THEIR FAMILES
MPUP SCHOOL, CHADULLA, SINGANAMALA , Anantapur .Dt
I here by declare that the statement in this application are true to the best of my knowledge and that The
person for whom medical expenses were incurred is a member of my family as defined in API Medical
Attendence Rules.He/She is dependent on me.Certified that my dependent is not a Govt.Employee.
SIGNATURE OF THE GOVT. SERVENT/PENSIONER AND THE OFFICE TO WHICH HE IS ATTACHED
NON - DRAWL CERTFICATE
Signature of the drawing and disbursing officer
Signature of the applicant.
DEPENDENT CERTIFICATE
Signature of the applicant.
Signature of the forwarding officer
This is to certify that the amount of Rs 8660/-.( Rupees eight thousand six hundred and
sixty only ) has not been paid previously ,towards medical reimbursement in respect of smt resma
w/o Sri Y.Gangi Reddy, S.G.T, MPUP SCHOOL, CHADULLA, SINGANAMALA Mandal,
Anantapur .Dt ,on his/her treatment taken during the period from 10-10-09 to 20-10-09 for the
Disease Consultation.Root canal treatment,Ceramic crowns, in the hospital Dentocare Super
Speciality Hospital Anantapur, and this is the first Spell for the disease and entered in the Medical
Reimbursement Register
I, Sri Y.Gangi Reddy, S.G.T, MPUP SCHOOL, CHADULLA, SINGANAMALA Mandal,
Anantapur .Dt hereby declare that smt , resma has no property of income of his/her own and that
he/she is wholly dependent on me. He/she is also not a employee or pensioner.
SRINIVAS GANDHAMANENI - 99594 22002 - 94402 69989
APTC FORM - 58
FULLY VOUCHRED CONTINGENT BILL
Payble at
For the Month & Year 12 2009DIST TREASURY OFFICE
DTO (PLANED)
District: Anantapur For Treasury use OnlyDate:-
D.D,O`s T.B.R.No Trans ID:-
1 0 0 1 Major Head 2 2 0 2
DDO Code: 1003567-0092 Sub - Major Head 0 1 Ele..Edn.
DDO Designation: M.E.O Minor Head 1 0 3
DDO, Office Name.
M.P.P
M.P.SINGANAMALA Group Sub - Head
Bank Branch Code 80 Sub - Head 0 5
Bank Branch Name: SBI Detailed Head 0 1 0 Salaries
B.K.SAMUDRAM
Sub - Detailled Head 0 1 7
Non-Plan = N/ Plan =P N Charged = C/ Voted = V: V 2 0 2
Gross Rs : 8660 Deduction Rs : - Net Rs:_ 8660
F tvÀô È¢ÀÀh¸åné ±µÃ8660 ( eight thousand six hundred and sixty only )
.F ¶mSµlµÀ / VÇOµÀÖ / f¸ñ¶pÁýà / P¹h¸Y¶¢À / ¶ª±µÀç s¹dÀ l¸ö±¸ VÇwôAVµAfº.
ËÈpOµ¶¢ÀÀdºà¶ml¼
f¸ñ VÉʪ Clû¼O¸±¼
f¸ñ VÉʪ Clû¼O¸±¼
FOR USE IN TREASURY / PAY & ACCOUNTS OFFICE ONLY
Pay Rs ……………………… (Rupees……………………………………………………………………………………..
……………………………………………………………………………………………………………………………………
…………………………………………. Only) by Cash / Cheque / Draft / Account Credit as under and Rs ……………
(Rupees ……………………………………………………………. Only) by adjustment.
TREASURY / PAOCODE
GeneralEducation
Asst. to local Bodies ,
Teaching grant to M.PS.
Medical reimbursment
Contingency Fund MH/Service Major Head
±µÃq¸±ÀµÀvÀ ¶¢ÃhµñÊమే
1. Rs……………………… by transfer credit to the S.B. Accounts of the employee (As per Annexure - 1)
2. Rs……………………… by trancefer credit to the D.D.O. Account towards non - government deducations.
NBST / Bank Seal
Treasury Officer / Pay & Accounts OfficerSrinvas Gandhamaneni - 99594 22002 * 9440269989 "www.apteachers.blogspot.com"
PARTICULARS OF AMOUNT CLAIMED IN THIS BILL
Amount
/2008
8660.00
Total 8660.00
( eight thousand six hundred and sixty only )
Non - Drawel Certificate
This is to certify that the amount climed in this bill was not drawn and paid previously
Total Amount Rs : 8660.00
( eight thousand six hundred and sixty only )
f¸ñ VÉʪ Clû¼O¸±¼
sfÇÝd³ £¶¢±¸vÀ1. 2008
±µÃ :
±µÃ :
±µÃ :
1.Budget provided for the year
2.Expenditure including this bill
3.Balance
f¸ñ VÉʪ Clû¼O¸±¼
COÓAdÉAdÀ Y¶m±µvÀ O¸±¸ïv±ÀµÀ G¶¶p±ÀÇÃS¸±µèA
No.& Description ofSub - Voucher
Details of expenditure and authority for sanction, drawal of amount
Medical reimbursment bill of smt resma w/o Sri Y.Gangi Reddy, S.G.T, MPUP SCHOOL, CHADULLA, SINGANAMALA Anantapur .Dt as per Prog R.C.No.5601/B5/2007 , dated 30-12-99 of the DIST.EDUCATIONAL OFFICER, ANANTAPUR.
¶ªA¶¢hµù±¸nOº sfÇÝd³ OÉd¹±À³ÀA¶pÁ
2. FtvÀôhÐ ¶ª¶¬ C±ÀÀ¶m ¶¢ö±ÀµÀA
3. nvÀ¶¢
Srinvas Gandhamaneni - 99594 22002 * 9440269989 "www.apteachers.blogspot.com"
ANNEXURE-I(Notifide Pay Bank) (Employee Wise Details)
Name of the NPB: SBI , B.K.SAMUDRAM NPB Code : 80
D.D.O.Code : 1003567-0092 Date : 12/12/2009
D.D.O.Designation: M.E.O
M.P.SINGANAMALA
S.No Employee Code Name of the Teacher Employee SBI A/C NoAmount
1 11111234567 Y.Gangi Reddy 123456789023 8660.00
TOTAL 8660
( eight thousand six hundred and sixty only )
Assistant Treasury OficerM.E.OM.P.SINGANAMALA ANANTAPUR
ANNEXURE-II(Notifide Pay Bank) (Employee Wise Details)
Name of the NPB: SBI , B.K.SAMUDRAM NPB Code : 80
D.D.O.Code : 1003567-0092 Date : 12/12/2009
D.D.O.Designation: M.E.O Trance-ID: 0M.P.SINGANAMALA
S.No Name of the NPB Purpose
1 SBI , B.K.SAMUDRAM 8660
TOTAL 8660
( eight thousand six hundred and sixty only )
M.E.OAssistant Treasury OficerM.P.SINGANAMALA
ANANTAPUR
Trance-ID:
Amount to be credited
Medical reimbursment bill of smt resma w/o, Sri Y.Gangi Reddy, S.G.T, MPUP SCHOOL, CHADULLA, SINGANAMALA , Anantapur .Dt.
ANNEXURE - IIIGOVT.BANK REPORT
TO BE GENERATED BY TREASURY OFFICE
Treasury Code: 80 Treasury Office Name : DTO ,ANANTAPUR
Govt. Bank Code: 80 Govt, Bank Name: SBI ,B.K.SAMUDRAM
S.No DDO Account Number Purpose
1 123456 ,
Total
( eight thousand six hundred and sixty only )
Signature of the Signature of the Bank Officer Treasury Officer(With Seal) (With Seal)
ANNEXURE - IIIGOVT.BANK REPORT
TO BE GENERATED BY TREASURY OFFICE
Treasury Code: 80 Treasury Office Name : DTO ,ANANTAPUR
Govt. Bank Code: 80 Govt, Bank Name: SBI ,B.K.SAMUDRAM
S.No DDO Account Number Purpose
1 123456 ,
Total
( eight thousand six hundred and sixty only )
Signature of the Signature of the Bank Officer Treasury Officer(With Seal) (With Seal)
Name & Code of N L B
Medical reimbursment bill of smt resma w/o Sri Y.Gangi Reddy, S.G.T, MPUP SCHOOL, CHADULLA, SINGANAMALA Anantapur .Dt.
Name & Code of N L B
Medical reimbursment bill of smt resma w/o Sri Y.Gangi Reddy, S.G.T,
MPUP SCHOOL, CHADULLA, SINGANAMALA Anantapur .Dt.
ANNEXURE - IIIGOVT.BANK REPORT
TO BE GENERATED BY TREASURY OFFICE
DTO ,ANANTAPUR
SBI ,B.K.SAMUDRAM
8,660
8,660
Signature of the Treasury Officer
(With Seal)
ANNEXURE - IIIGOVT.BANK REPORT
TO BE GENERATED BY TREASURY OFFICE
DTO ,ANANTAPUR
SBI ,B.K.SAMUDRAM
8660
8660
Signature of the Treasury Officer
(With Seal)
Amount to be Credited
Amount to be Credited
ANDHRA PRADESH GOVERNMENT
(PAPER TOKEN)
STO Code: 1 0 0 1 (For Treasury Use Only)
Date :DTO/STO Name: Anantapur
Trans ID:DDO Code: 1003567-0092
DDO Designation : M.E.OM.P.P
M.P.SINGANAMALA
Bank Branch Code: 80 BANK Name: SBI
B.K.SAMUDRAM
Head of Account 2 2 0 2 0 1 1 0 3
(Major Head) (Sub - MH) (Major Head) (Grp - SH)
0 5 0 1 0 0 1 7
(Sub Head) (Det. Head) (Sub - Det. Head)
N V 2 2 0 2
Gross Rs. 8660.00 Deducation Rs. Nill Net Rs. 8660.00
( eight thousand six hundred and sixty only )
Messenger Name Designation
2
DDO Signature Attested STO Signature
DDO Signature
DDO Office Name:
Non - Plan = NPlan =P:
Charged = C Voted = V:
Contingency Fund MH/Service Major Head
(As in APTC From - (101)
Specimen Signature of Messenge
1.
D D O Seal
TreasurySeal
APTC FORM 101
(See Subsidiary Rull 2 (W) Under Treasury Rule 15
Govt. Memo No :38907 / Accounts / 65-5, Dt 21.02.1993)
DDO Code 1003567-0092 Treasury/PAO Code 1 0 0 1
M.E.O Treasury/PAO Name: DTO ,ANANTAPUR
To
The Treasury Officer/Manager
SBI
B.K.SAMUDRAM
Please Pay Bill No dated for Rs 8660
( eight thousand six hundred and sixty only )
to Smt/ Sri
whose specimen Signature is attensted herewith.
Signature of the Govt. Servant Received the payment
Dated : Dated
Attested
Signature of the D D O Signature of the Govt.
Servant receiving the
Payment
DDO Designation
D D O Seal
ESSENTIALITY CERTIFICATE CERTIFICATE "A"
(To be completed in the case of patients who are not admitted to Hospital for treatment)
#REF!
I , DR.M.Venkata Krishna Murthy here by certifiy :-
a) That I charged and received Rs 100 for consulting at my room/at patient residence
b) That I charged and received Rs for administering
Intra venous/mascular /sub-cutaneous Injection on at my
consulting room/at patient residence
c) That the injections administered was/were not for immunizing or prophylactic purpose
d)
Name of medicines Price
e) That the patient is/was suffering from Sever Attrition,Badly decayed teeth
and is /was under treatment from ### to ###
f) That the patient is/was not given pre-natal or post- natal treatment
g)
h) That I refered the patient to Dr for specialist consultation
and that necessary approval of the
(Name of the Chief Admin.Medical Officer of the State as required under the rules was obtained)
i) That the patient did not require Hospitalization
j) That the mixture / ointment /powder entered at serial ( ) undet Certificate (d) could not be
dispensed at the Hospital and the patient was advised to buy it from the market
Date:-
Note:- Certificates not applicable should be struck off.certficate (e) is compulsory and must be filled in by the Medical officer in all cases
That the patient has been under treatment at Dentocare Super Speciality Hospital / my consulting room, and that the undermentioned medicines prescribed by me in thes connection were essential for the recovery / prevention of serious deterioration in the condition of the patient.The medicines are not stocked in Dentocare Super Speciality Hospital for the supply to private patients and do not include proprietary preparations for which cheaper substances of therapeutic value are available not preparations which are primerily foods,toilets or disinfectants
That the X-ray / Laboratory tests / treatment etc.. For which an expenditure of Rs 8660/-( Rupees eight thousand six hundred and sixty only ) was incurred were necessary and were undertaken on my advice at Dentocare Super Speciality Hospital Anantapur
Sign of the AMA/Designtion of the Medical Officer, and Hospital / Dispensary to which attached
GOVT. OF ANDHRA PRADESH
(APTC Form - 47)Payable at D.T.O, Anantapur
Pay Bill for the Month & Year 09 2009 (For Treasury Use Only)
Date :- 12/12/2009D.D.O., Anantapur 1 0 0 1
Trans ID : 345
D.D.O. Code 1001-0308-01District : ANANTAPUR
D.D.O.Designation HEADMASTER DDO Office Name : Mandal ParishadGHS NO.1 Anantapur Anantapur Rural
Bank Code 0 2 5 0 Bank Name : SBI,ANANTAPUR
D.D.O.' s TBR No:-. Permanet / Temporary:-
Head of Account Deductions
Major Head General Education 1 GPF/AIS/PF Rs.
2 APGLI Rs.
Sub Major Elementary Education 3 Group Insurance/AIS Rs.
4 Professional Tax Rs.
Minor Head 5 House Rent Rs.
6 Festival Advance Rs.
Group Sub-Head 7 Apco Advance Rs.
8 Education Advance Rs.
Sub Head 9 H.B.A. (P) Rs.
10 H.B.A. (I) Rs.
Detailed Head Salaries 11 Car Advance (P) Rs.
12 Car Advance (I) Rs.
13 Motor Cycle Advance (P) Rs.
Non-plan=N/Plan=P N Charged=C/V V 14 Motor Cycle Advance (I) Rs.
Voted=V : 15 Cycle Advance Rs.
16 Marriage Advance (P) Rs.
17 Marriage Advance (I) Rs.
011 Pay Rs. 3662.00 18 Income Tax Rs.
012 Allowances Rs. 19 Class IV GPF-DTO Rs.
013 Dearness Allowance Rs. 1066.00 20 E.W.F. Rs.
015 HRA Rs. 493.00 21 ZPPF (8338) Rs. 5233.00016 CCA Rs. 12.00 22 Rs.
IR 0.00 Total Govt. Deductions Rs. 5233.00Gross Amount Rs. 5233.00 Total Non-Govt. Deduction Rs.
Less Amount Rs. 5233.00
AG Net Amount Rs. 0.00 Total Deductions Rs 5233.00
AG Net Amount in words
D.D.O's SignatureFOR USE IN TREASURY / PAY & ACCOUNTS OFFICE ONLY
Pay Rs. …………...………….……... (Rupees …………………………..…………………………………………………
………………………………...……………………………..…only) by Cash / Cheque / Draft / Account Credit as under and Rs. ……………………………………………………….
(Rupees ………………………………..………………………………………………………………………………………………only) by
1
2
Treasury Officer / Pay & Accounts Officer
Assistance to Local
bodies on primery Edn
Teaching Grants to M.Ps
Contingency Fund MH/ Service Major Head
Rs. …………………. ……………………………..By transfer credit to the S.B. Accounts of the employees (As per Annexure - I).
Rs. …………………………………………………….. by transfer credit to the D.D.O. Account towards non-government deductions.
NBST / Bank Seal
SRINIVAS GANDHAMANEN I - 99594 22002 - 94402 69989
BUDGET DETAILS
1. BUDGET ALLOTMENT FOR THE YEAR Rs.
2. EXPENDITURE INCLUDING THIS BILL Rs.
3. BALANCE Rs.
DDO
The bill amount Rs 5833
( )
Received Amount Rs
DDO
DDO
Required Certificates
1 Certified that the Amount was not drawn paid previously.
2 Certified that the Pay Amount was calaimed G.O.MS.No. 180 Dated 29-6-06
3 Certified that the D.A. Amount was Claimed G.O.MS NO 139.Dated 5-6-08
4 Certified that the D.A. Amount was Claimed G.O.MS NO 19,Dated :-2-2-07
5 Certified that the D.A. Amount was Claimed G.O.MS NO :-133,Dated:-12-06-07
6 Certified that H.R.A. Amount was Claimed G.O.MS.No.181,Dated 29/06/2006
7 Certified That C.C.A Amount was Claimed G.O.MS.No.182,Dated 29/06/2006
8 Certified That I/R Amount was Claimed G.O.MS.No.303,,Dated 15/10/08
9 Certified that the Pay Amount was calaimed G.O.(P).No. 241 Dated 28-09-2005
10 G.O.M.SNo.54 Education ( SE-SER-III) Departmrnt dated 02-08-07.
11 G.O.M.SNo.38 Education ( SE-SER-III) Departmrnt dated 26-05-07.
12 Certified that necessary entries were made in the individual S.R
DDO
FOR USE IN ACCOUNTANT GENERAL OFFICE
SRINIVAS GANDHAMANEN I - 99594 22002 - 94402 69989